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General NPI Number Information
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NPI Number | 1114269032
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Entity Type | Organization
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Legal Business Name | HOLISTIC FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 03/18/2013
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Last Update Date | 03/18/2013
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Provider Practice Location Address
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Address Line | 430 OLD SIB RD
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City | RIDGEFIELD
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State | CT
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Zip | 06877-2335
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Country | US
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Telephone | 203-826-3582
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Fax | 855-798-2816
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Provider Business Mailing Address
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Address Line | 430 OLD SIB RD
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City | RIDGEFIELD
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State | CT
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Zip | 06877-2335
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Country | US
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Telephone | 203-826-3582
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Fax | 855-798-2816
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOMENICK JOHN MASIELLO
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Credential | DO
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Telephone | 203-826-3582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 000278
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 000278
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License Number State | CT
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